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- 內視鏡治療在總膽管結石的應用
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題 名 | Diagnosis and Treatment of Post-Operative Biliary Leaks=手術後膽汁滲漏的診斷與治療 |
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作 者 | 陳瑞灝; 楊國卿; 劉玉華; 徐以信; 孫灼基; 廖朝聖; 林家立; | 書刊名 | 中華民國消化系醫學雜誌 |
卷 期 | 17:4 2000.12[民89.12] |
頁 次 | 頁18-24 |
分類號 | 416.247 |
關鍵詞 | 膽汁滲漏; 內視鏡括約肌切開術; 鼻-膽道引流術; 經皮導管引流術; Biliary leaks; Endoscopic sphincterotomy; Endoscopic nasobiliary drainage; Percutaneous catheter drainage; |
語 文 | 英文(English) |
中文摘要 | 膽汁滲漏常發生予腹部手術、外傷、經皮穿肝膽道引流術或肝腫瘤之動脈栓塞後 ,其中又以腹部手術後最多。膽汁滲漏的治療過去多以外科療法為主,但是自從膽道內視鏡 術發展之後,各種非外科的療法便被引進此一治療領域,本文主旨在探討各種非外科療法 ( 包括經皮導管引流術,內視鏡括約肌切開術,鼻一膽道引流術 ) 對予本病的治療效果。 自 1994 年 4 月至 2000 年 3 月,本院共收集了 19 位手術後發生膽汁滲漏的病人, 其診斷 的方法包括超音波、電腦斷層掃描、核醫膽道攝影、經皮抽吸外滲的膽汁及經內視鏡逆行性 膽管攝影,而治療的方法已如上述,以非外科的療法為主,少數病人仍輔以外科治療。滲漏 的位罝以膽囊管 (6) 及總膽管 (2) 為主。另外在左側肝內膽管 (1) 及右側肝管 (2) 亦偶 而可見,但有 3 例病人,雖知有膽汁外滲但無法確認滲漏的位置。 治療的成效方面,有 7 例病人在作過經皮導管引流術,解除膽汁性腹膜炎之後,滲漏自動停止。 另外,12 例病人 接受了內視鏡治療,其中包括 2 例內視鏡括約肌切開術, 3 例內視鏡鼻膽管引流術,6 例 則接受前述兩種治療。 19 例中有 18 例病人的膽汁滲漏經上述的非外科療法之後,滲漏停 止,停止的時間在治療後 2 到 30 天之間。失敗的 1 例病人係因為逆行性膽管攝影失敗, 後經外科治療後痊癒。 另有 3 例病人雖膽汁滲漏已停止,但因次發性感染引起腹腔膿瘍, 經外科手術引流後痊癒。因此我們的結論是膽汁滲漏的病人經非外科的療法大部份可以痊癒 ,僅少數病人需外科介入。 |
英文摘要 | Biliary leaks may occur after abdominal surgery, trauma, percutaneous transhepatic cholangiography or transcatheter arterial embolization of hepatic tumor:Various non-surgical methods have been used in the treatment of biliary leaks. This study demonstrated the efficacy of percutaneous catheter drainage (PCD) of biloma, endoscopic sphincterotomy (EST) , endoscopic nasobiliary drainage (ENBD) and surgery. From April 1994 to March 2000, 19 patients were referred for management of post-operative biliary leaks. Diagnostic studies included sonography, computed tomography (CT scan) , cholescintigraphy, aspiration of biloma, and endoscopic cholangiography (ERC) . Therapeutic procedures included PCD, EST, ENBD and laparotomy. The leak sites were the cystic duct stump(6), right hepatic duct (2), left intrahepatic duct(1), common bile duct (7), and undefined (3). Eleven patients received PCD and in 7 of them the leak healed withoug further therapeutic endoscopy or surgery. Five patients among the latter belonged to biliary leaks fellowing T-tube removal. Eleven patients received therapeutic endoscopy (EST in 2, ENBD in 3 and both in 6). For most patients biliary leaks healed within 2 to 30 days after various non-surgical interventions except for three patients who required laparotomy for abscess drainage (2) or for failed ERC (1). Non-surgical treatments of biliary leaks were effective in most of our patients. Laparotomy for biliary leaks with or without abscess drainage is occasionally required. Most of our patients recovered well except one patient who had biliary stricture as a late complication. Biliary leaks after T-tube removal can usually be treated by PCD alone and therapeutic endoscopy or surgery is not needed. |
本系統中英文摘要資訊取自各篇刊載內容。